Testing the Sociocultural Model of Eating Disorders: A Cross-National Analysis of Income Inequality, Gender Equality, and Eating Disorder Rates

We present the first study to examine associations between national income inequality, gender equality, and eating disorder burden and online discussion. These factors have been linked with other health outcomes (e.g., depression) and relevant psychological outcomes (e.g., comparison, objectification). We use estimates of eating disorder DALY rates from the Global Burden of Disease Study (Study 1, N =204 nations) and eating disorder tweeter rates (Study 2, N =104 nations). We measure income inequality using the Gini index and gender equality using five measures: gender equality in education, paid work, and parliament, the Hill/Karim Index, and the Gender and Social Norms Index. We group countries into regions, reporting within- and between-region associations controlling for national development. Within-region, we find limited evidence that income inequality and gender equality are associated with eating disorder DALYs or tweeter rates. Between-region, income inequality was associated with higher eating disorder DALYs and tweeter rates; findings for gender equality were mixed in Study 1, and in Study 2, gender equality was associated with higher eating disorder tweeter rates. Within-region null findings may reflect limited statistical power and regional homogeneity. Between-region, income inequality was associated with higher eating disorder burden and online discussion, consistent with previous research linking income inequality with poorer health. Between-region results for gender equality were mixed; however, we found almost no evidence that gender equality was correlated with fewer eating disorders. Between-region analyses should be interpreted with caution due to low statistical power. We discuss implications for theory and measurement. • Data from 204 countries test correlates of national eating disorder rates • Gender equality was not reliably associated with eating disorder rates • Income inequality was associated with higher eating disorder rates between-regions • Extends evidence on national determinants of population health